Introduction Low back pain can be influenced by demographic, lifestyle and co-morbid factors. No studies have been done on the relationship between these factors and low back pain in hospital employees in South Africa. The aim of this study was to determine which of these factors was present and how they influenced low back pain in staff employed at a district hospital in South Africa. Methods The study used a self-administered questionnaire on staff employed at the hospital. Results Results indicated that the point prevalence for low back pain was 47%. Most of the employees were female nurses aged between 26 and 40 years with BMI values higher than normal. The majority of the employees participated in exercises although this was mainly for 1 to 2 times a week. Among the demographic factors, only female gender was associated with increased risk of low back pain (OR 1,67 CI 1,04 ; 2,69) while for the lifestyle factors, participation in group exercises was a protective factor against low back pain (OR 1,66 CI 1,02 ; 2,70). Perceived stress all the time increased the risk of low back pain (OR 3,47 CI 1,46 ; 8,23). None of the isolated co-morbid diseases were associated with the presence of low back pain. Conclusion The prevalence of low back pain among Tshwane district hospital employees is high. Female gender and a high level of perceived stress increase the risk of low back pain while participation in group exercise reduces the risk of low back pain.

A Thesis submitted to the faculty of Commerce, Law and Management, University of Witwatersrand, School of Governance in 50% fulfilment for the Master of Management in the field of Monitoring and Evaluation 9 May 2016 / The purpose of the study was to analyse the Supply Chain Management (SCM) approaches used in the Public Hospital Outpatients Pharmacy and compare the findings with successful supply chain practices from other industry sectors. The study of academic literature locates the unavailability of drugs in the public hospital pharmacies to the domino effect of the lack of governance and accountability in the public hospital. The data for the study was gathered from public and private hospitals in Gauteng, and large FMCG manufacturers and retailers. The study finds that the public sector adoption of SCM in the absence of a coherent technology and human resource support environment results in a lack of accountability and coherence across systems. The research study corroborated the view of academics and the interviewees that the unavailability of drugs in the public hospital is a multidimensional problem that has its roots in the lack of governance throughout the drug supply chain. It is a complex manifestation of policy, processes, practices, structure, people, communication and donor funding that contribute to the problem. Resolving the drug availability issues will require the ‘whole supply chain re-engineering’ with the added focus on developing the operational capability and capacity of the actors within the supply chain continuum. / MT2017

MPH (Hospital Management), Faculty of Health Sciences, University of the Witwatersrand

No description available.

Digitized by Kansas Correctional Industries

Burns can represent devastating injuries surgically, psychologically and socially. A multidisciplinary team approach to patient management is requisite to successful patient management. Burns education is currently under-represented in national undergraduate surgical curricula with a resultant graduating workforce with sub-optimal burns management knowledge. There is therefore a drive to improve burns education nationally. In order to develop burns teams to perform with skill and efficiency, it is important to develop and advance their technical and non-technical skills. Simulation has proven to be a powerful modality to augment surgical training. Recreating authentic clinical challenges is crucial in optimising simulation-based team training. The majority of such team-based simulation takes place in dedicated simulation facilities or centres which are static and can be costly. This thesis presents eight peer-reviewed publications that chronologically represent a thematic series of publications in simulation and surgical education with an ultimate focus on burns education. The theoretical framework explores simulation strategies in light of educational theory, culminating in the development of "The Burns Suite" (TBS); a novel modality to advance the delivery of interprofessional burns education. TBS represents a low-cost, high-fidelity, portable, immersive simulation environment. It facilitates the delivery of an interprofessional realistic burn resuscitation scenario based on "advanced trauma and life support" (ALTS) and "emergency management of severe burns" (EMSB) principles. Scenarios were refined utilising expert opinion through cognitive task analyses. Participants considered TBS experience authentic due to its high psychological and social fidelity. This thesis contributes to burns surgical education by providing a better understanding of educational theory underpinning successful simulation and facilitating its interprofessional delivery via TBS. This approach can facilitate the design of future simulation scenarios that provide unique educational experiences where team members can learn with and from other specialties and professions in a safe, controlled environment. Addressing economic and practical limitations of current immersive surgical simulation is important. The low-cost approach of TBS has major implications for surgical education as a whole, particularly given increasing financial austerity. This thesis proposes that alternative, complex, and challenging scenarios and/or procedures can be recreated within TBS, providing a diverse educational immersive simulation experience that can be extrapolated into other surgical specialities and interprofessional arenas.

Class of 2007 Abstract / Objectives: To describe the after-hours medication needs in rural hospital pharmacies which are closed during the night. Methods: Entries in a night medication log from a 60 bed rural Arizona hospital that closed for 12 hours at night were collected. Complete entries were assigned a night of the week, a month of the year, and a two hour time period. Data was collected from April 1, 2005 to March 30, 2006. Entries were sorted into groups, counted, and ranked. Groups were compared using student’s t-test. The top 200 drug products ranked by quantity was recorded for a trial of fit into a night formulary. Results: The night medication log contained 4986 complete entries accounting for 669 individual drug products. Non-pharmacy staff entered the pharmacy after-hours 2070 times and removed 10449 drug dosage units. No significant difference in night medication need was found between summer and winter month or weeknight and weekend night. Early night need was significantly different than late night need (p = 0.01). The top 200 drug products covered 83.3% of the medication quantity need of the hospital. Conclusions: The study found that a large percentage (83.3%) of the night medication need could be accessible from a 200 item night formulary. Seasonal and weekend differences were non-significant with only time of night differences being significant. These results could justify the extending of current hours or establishment of a night formulary to decrease entrances into the pharmacy when a pharmacist is not on duty.

Através da metodologia “Observação Estruturada” foram estudados 5 (cinco) adm inistradores hospitalares de hospitais filantrópicos gerais de grande porte no estado do Rio Grande do Sul, durante uma semana cada um, observando, minuto após minuto, dia após dia, como eles executam seus trabalhos. O estudo, que utilizou as mesmas categorizações de Mintzberg (1973), conclui no mesmo sentido de Mintzberg de que também o Administrador Hospitalar “não é um planejador sistemático e reflexivo, mas sim um profissional que executa suas atividades em ritmo intenso, com as características de brevidade, fragmentação e variedade. É firmemente orientado para a ação e vê-se constantemente bombardeado por telefonemas, correspondências e por pessoas que às vezes irrompem em sua sala para fornecer-lhe ou dele receber informações” (pág. 28-53, 1973). Utiliza-se intensamente da comunicação verbal e apóia-se em extensiva rede de contatos externos à organização hospitalar para a obtenção e troca de informações. A principal diferença entre os Administradores Hospitalares por mim pesquisados e os gerentes analisados por Mintzberg é que aqueles envolvem-se num número expressivamente maior de negociações do que estes. Enquanto que 10% (dez por cento) do total de contatos dos Administradores Hospitalares referem- se a negociações, apenas 1% (um por cento) do total de contatos dos gerentes estudados por Mintzberg refere-se a esse papel. A dinâmica e complexa interação dos quatro mundos do hospital (Mintzberg,1977): cura, cuidados, controle e comunidade são fontes de constante pressão em seu trabalho, desafiando suas habilidades (técnicas, humanas e conceituais) e exigindo-lhe elevada capacidade de observação, de negociação, de administração do tempo e de controle emocional, ao lado da competência em argumentar, em falar em público, em conhecer o sistema de saúde e em inter-relacionar-se com os demais profissionais da saúde.

Thesis (MSc ( Med In Pharmacy)) -- University of Limpopo (Medunsa / Summary Summary Summary The words “researcher” and “pharmacist” are used interchangeably. In the last two decades, the role of the pharmacist has been expanding beyond product orientated functions, such as procurement, stock control and dispensing, towards patient centered functions, in which the pharmacist assumes responsibility for treatment outcomes as part of the health care team. This research aimed to assess the need for the provision of pharmaceutical care from the pharmacist to the surgical wards of Steve Biko Academic Hospital. The objectives of the study were to determine the role of the pharmacist in the general surgical wards, to assist in the design of an antimicrobial ward protocol for the surgical wards, to record and assess antimicrobial patterns in the surgical wards, to describe and categorize the interventions performed by a pharmacist during the provision of pharmaceutical care, to identify factors which limited the provision of pharmaceutical care and provide recommendations for future undertakings, to calculate the cost implications of pharmaceutical care interventions made, to assess the time spent on interventions performed by a pharmacist during the provision of pharmaceutical care and to determine if the medical staff members in the surgical unit feel there is a need for the pharmacist providing pharmaceutical services to the wards. The study was conducted in the surgical wards of Steve Biko Academic Hospital. The study design was a cross-sectional operational study in which 62 patients were recruited over the eight week period. A pilot study was conducted to validate the data collection instruments. The data was analyzed with the assistance of a statistician using various statistical methods for the different variables in the study. ix Of the 62 study patients, 33 were female and 29 were male. The female-to-male ratio of the study patients was thus 1:0.88. The average age of the patient population, was 52.5 ± 17.2 years, with a range of 15 to 88 years. The mean duration of stay for the study patients was 8.9 days, with a range 1 to 111 days. A total of 120 diagnoses were made for the 62 study patients. Conditions diagnosed most frequently included conditions affecting the gastro-intestinal tract (38 patients), conditions affecting the cardiovascular system (28 patients), conditions affecting the endocrine system (14 patients) and infections (12 patients). The five medicines used most frequently in terms of numbers of patients and duration of therapy were paracetamol (53 patients, 277 patient-days), morphine/papaverine/codeine (41 patients, 155 patient-days), enoxaparin sodium (24 patients, 113 patient-days), co-amoxiclav (21 patients, 101 patient-days) and metoclopramide (22 patients, 90 patient-days). A total 188 interventions were made and documented during the study period and 153 (81.4%) interventions were accepted. The number of interventions suggested ranged from 0 to 10, with an average of three interventions per patient and a median of one intervention per patient. The most frequent interventions were made due to system error or non-compliance (29.3% of all interventions), on patient or nursing staffs’ knowledge of the medication (18.6%), untreated medical conditions (11.2%), therapeutic duplications (9.0%) and on prescribed doses and dosing frequency (5.9%). The total time spent providing pharmaceutical care services within the surgical wards over the study period was 32 days (227.9 hours) with an average time of 7.1 hours per day. Of the total time in the ward, 48% was spent on providing pharmaceutical care to the patients, 26% to record and access the total antibiotic usage in the ward, 9% on administration and 6% on meetings. Other functions comprising of 3% and less of the time was information to patients, x communication with doctors, educational sessions with nursing staff, communication with the pharmacy and stock control procedures. Questionnaires were completed by the doctors and nursing staff before and after the study period to determine if they felt there was a need for a pharmacist in the surgical ward. The doctors felt that there was a need for a pharmacist in the ward in terms of providing information and assisting in the rational use of medication. All of the nursing staff felt that there was a need for a pharmacist to visit the surgical ward and specifically to assist with the legal aspects of the prescriptions and with the education of the nursing staff. The pharmacist played an important role in the design of an antimicrobial ward protocol and in order to do so the pharmacist recorded and assessed the antimicrobial prescribing patterns of the surgical wards. In conclusion, the pharmacist present in the ward functioned as a gateway between the nursing staff and the doctors. The interventions that require the most attention was made due to system error and non-compliance. Important interventions were made on the patients’ and nursing staffs’ knowledge of the prescribed medication. The pharmacist played an important role in the education of nursing staff to discuss relevant topics and problems often encountered. Educational sessions with the patients involved giving them advice on home medication and the medication prescribed to them to take home. The amount of patients seen per week increased with time and the average time spent per patient consultation decreased with time. This is a clear indication that the researcher gained confidence and became more familiar with the pharmaceutical care process as the time passed. From the questionnaires completed by the doctors and nursing staff it was clear that they felt that there was a need for a pharmacist in the ward in terms of xi providing information, assisting in the rational use of medication, to assist with the legal aspects of the prescriptions and with the education of the nursing staff.

My thesis comprises a creative and a critical component. The creative component is a novel entitled Ambergris. Ambergris in both its synthetic and natural states is a fixative to contain the evanescence of scent; it is also a metaphor for my novel which is set against the background of perfume making and deals with expatriates and migrants. Through the formal structure of the novel I hope to make a contribution to literature and to engage with critical and social concerns of the expatriate condition such as the place of home, the experience of longing, and whether or not one can really ‘belong’. My critical essay is entitled "The Smell of Dislocation: Olfactory Imagery in Selected Works of Janette Turner Hospital". The words 'olfactory imagery' may seem to be a contradiction in terms due to the difficulty of containing scent and the paucity of olfactory language. Scent, however, has strong links to memory and place, and through its non-visual and associative qualities may bypass language. I argue that engagement with the representation of scent in fiction can expand the current categories of formalist criticism found in narrative theory and Creative Writing pedagogy. My essay examines how Janette Turner Hospital employs olfactory imagery in her ‘Australian’ stories and novels to represent the recurring themes of dislocation underscoring the lives of many of her characters. Despite the difficulty of representing smell in fiction, I explore possibilities for thematic considerations triggered by the percept of smell as experienced by Janette Turner Hospital's characters, narrators, and possibly readers. Such explorations deal with the links between scent and memory, the liminality of both scent and the expatriate condition, as well as a narrative methodology which considers psychological and cognitive reactions to scent and culminates in their 'mapping' and the 'slippage' of personal associations. Both thesis components examine expatriate identity and approach its fictional representation through the filter of expatriate perceptions. Awareness by readers of such perceptions may serve to amplify their own appreciation of the dislocation of such identities in fiction, and in our current world of growing and even shifting diasporas.